PSYCHOSOMATIC EFFECTS OF ANXIETY (IZTARAB-E-NAFSANI) AND ITS MANAGEMENT
HTML Full TextPSYCHOSOMATIC EFFECTS OF ANXIETY (IZTARAB-E-NAFSANI) AND ITS MANAGEMENT
Abul Faiz *, Ferasat Ali and Ashhar Qadeer
Regional Research Institute of Unani Medicine, Aligarh, Uttar Pradesh, India.
ABSTRACT: The whole world is facing very serious problems, in which anxiety is a common problem throughout the world, and is defined as a feeling that, whether people like it or not, they must experience in order to survive. The physical as well as biochemical properties of the body are represented in terms of the Temperament (Mizaj) of individual. The Unani system of medicine is a thorough one that carefully considers both healthy and unhealthy conditions. It is founded on the idea of homeostasis, and one of the six key factors is the disturbance of psychic movement and repose, which weakens tabi'at (physis) and, in turn, alters an individual's humours and temperament (su'al mizaj), which further weakens tabi'at and tends to cause sickness. In Unani system of medicine great reliance is placed on the prevention from diseases (Tahaffuz) and preservation of health (baqa-e-sehat), has been defined under six essential factors of life (Asbab-e-sitta zarooria). There are four modes of treatment to combat anxiety, i.e. Ilaj-bit-Tadbeer (regimenal therapy), Ilaj bil Ghiza (dietotherapy), Ilaj-bil-Dawa (pharmacotherapy) and Ilaj-bil-Yad (surgery). This paper aims to describe the anxiety, its pathophysiology and basic principles of management in unani medicine.
Keywords: Psychic reaction, Temperament, Humors, Regimenal therapy, Dietotherapy, Pharmacotherapy
INTRODUCTION: As per the World Mental Health Survey (WMHS), the lifetime prevalence of anxiety disorders (ADs) across different countries ranges between 3% and 19% 1. The Global Burden of Disease 2015 ranked as the sixth-largest contributor of years lived with disability 2. Spielberger defines anxiety as an activation of the autonomic nervous system that is accompanied by a subjective experience of unease, tension, trepidation, and worry. Hippocrates (460-377 B.C.), the father of medicine to whom psychiatry owes a great deal, is credited with first introducing the concept of Amraz-e-nafsaniya (psychiatric illnesses).
Spielberger defines anxiety as a personal experience. He was the one who originally asserted that the brain is the body's most vital organ and that it is the only place where our happiness, joy, laughter, and joke, as well as our sadness, pain, grief, and tears, originate. Further references to this idea can be found in the writings of Asclepiades, Arastaeus (150–200 A.D.), Galen (131–210 A.D.), Rhazes (850–925 A.D.), Al-Majusi (930–994 A.D.), Abu Sahal Masihi (1010 A.D.), and Avicenna (980–1037 A.D.), among other Unani medical authorities.
They have all mentioned psychiatric disorders viz. delirium, melancholia, hysteria, insomnia, etc., and even philosophized about the reasons for various states of mind. While describing the faculties of the human body, they have made a separate mention of Quwwat Nafsāniya (NUMC: O-2.6.2), the psychic faculty. Avicenna has written a psychological treatise in his book, Al-Qanun fit-Tibb (The Canon of Medicine), in which he postulated five faculties of the interior senses. Ibn-e-Nafees (1210–1288 A.D.), in his book, Kulliyat-e-Nafeesi (Book on Fundamentals, written by Nafeesi), has dealt with the effect of psychological signs and symptoms on the body.
Izterab-e-Nafsani (Anxiety): Anxiety means "to vex or worry," whether psychological stress exists or is not. It can instill feelings of anxiety, dread, worry, and terror. It is a particular emotion that a person needs to prepare for potentially dangerous or scary events. Anxiety is described by the American Psychological Association (APA) as "an emotion marked by feelings of tension, anxious thoughts, and bodily changes, such as elevated blood pressure."Function of the body whether health or disease are regulated mainly by four humors 3. Hippocrates describes the health is the primary state in which fluids are present in correct proportion in the body. Worldwide, one in five people meet with clinical criteria of anxiety disorder at least once in their lives 4. The symptoms of generalized anxiety disorder (GAD) will often include; restlessness, uncontrollable feelings of worry, increased irritability, concentration difficulties, and sleep difficulties 5.
Pathophysiology of Anxiety: Anxiety is one of the main symptoms of a variety of mental diseases, which includes generalised anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobic disorders. It is yet unknown how anxiety disorders function. Environmental stressors like difficulty at work, relationship issues, etc.; genetics; medical variables such the withdrawal symptoms from an illicit substance; and environmental stressors like genetics are also potential causes. Current evidences suggest that the neurobiological mechanism of anxiety was related to deregulation of serotonergic, noradrenergic, glutamatergic and GABA-ergic transmission 6.
Izteraab-e- Nafsaani (Anxiety) is a feeling that is necessary in order for human beings to live, whether they like or dislike it. The phenomenon of anxiety is not new; the description of anxiety disorders in classical literature of Unani medicine is available, but in separate expression as melancholia (Mālankhūliyā NUMC: A-19), insanity (Junūn NUMC: A-20), insomnia (Sahar NUMC: A-13) and palpitation (Khafaqān NUMC: E-2) 7. In Unani Medicine (UM), anxiety comes under the Infi’alat-e-Nafsaniyah (Psychic Reactions). Terminologically Infi’alat-e-Nafsaniyah are the movements of pneuma (rūh NUMC: O-2.4) and blood with the help of vital faculty (Quwwat Haywāniyya NUMC: O-2.6.3). According to Unani System of Medicine, anxiety is controlled by Quwwat-e-Mutafakkirah (faculty of thinking) which belongs to Quwa-e-Mudrika Batinah (internal perceptive faculties) of Quwwat-e-Nafsaniyah (psychic power NUMC: O-2.6.2) 8. Quwwat-e-Mutafakkirah is found in Ausat Dimagh 9, 10.
The causative factor of izterab-e-nafsani is Ghalba-e-Sauda/Safra (abnormal accumulation of bile), which in due course of time /in chronic course is transformed into abnormal black bile (Sawdā ghayr Tabī‘ī NUMC: O-15) due to the burning of Safra or other humours (Akhlat NUMC: O-2.3) 11, 12, 13, 14.
Unani scholars consider Ghair Taba’i Sauda (Abnormal black bile) as the main cause and basis of psychological and psychiatric disorders e.g. anxiety, depression, melancholia etc, whether it is associated with the Ehteraq (combustion) of blood (Dam NUMC: O-2.3.1), Phlegm (Balgham NUMC: O-2.3.2), bile (Safrā NUMC: O-2.3.3) or black bile (Sawda NUMC: O-2.3.4) itself 13, 14. Ibn-e-Sina has stated in his renowned book Al-Qanoon fit-Tibb, that the Mizaj (temperament) of Khilt-e-Saudawi (Black bile) is Barid Yabis (cold and dry) which is contrary to the Mizaj of Rooh-e-Dimagi (temperament of mental/vital spirit) thus resulting in derangement of Rooh-e-Dimaghi and leading to Khauf (Fear) 15.
Basic Principles of Management (Usool-e-Ilaj):
General Measures: Tibb-e- Unani (NUMC: UM) deals the patient on holistic parameters jointly together for preventive and curative aspects. Some general measures to avoid as well as to treat anxiety is based on removal of predisposing factors, adequate sleep, avoidance of heavy work, avoid smoking and alcohol consumption, avoid visiting dark, overcrowded and dirty places.
Prevention: In preventive aspect different types of oils obtained from herbal medicine are used as massage which helps in relaxing of muscle spasm and other physical state to create calm in the body. For example Roghan Labub-e- Sab’a, Roghan-e- Kahu, White Gourd Seeds etc. are used as local applicant. Furthermore orally used drugs like Murrabajaat and Muffarrehat (exhilarants) also provide the basic ingredients that are helpful as adjunct therapy for nervous tension and other similar symptoms. Mufarrehat (exhilarants) are one of the most critical requirements in the essential medicament of psychological disorders. Unani scholars have strongly advocated the use of Mufarrehat (Exhilarants) in psychiatric diseases after evacuation of vitiated humors from the body 16, 17, 18.
Distracting the mind through adaptive changes and distracting methods are the basic principle of treatment to make the patients comfortable and happy. Adaptive changes include living in a clean, well-lit house, which has provisions for fresh air breezes, wearing white or pastel shades, ensuring comfort and entrusting with responsibility. Distracting methods include visiting hill stations and parks, viewing plays, hearing pleasant music, being in company of religious people, listening religious sermons and interesting stories, reading books and inculcating hobbies etc.
Tanqiya-e-Mawad and Tarteeb: Evacuation and excretion of Ghair Taba’i Sauda through Munzijat (concoctive), and Mushilat (purgatives) followed by Tarteeb (moistness) is the second line of treatment for psychological disorders. Moistness is always essential after excretion of abnormal black bile to check and reduce the dryness which Tanqiya produces. Ibn-e-Sina has stated that due attention must be paid towards Tarteeb-e-Mizaj (moisturizing the temperament) in cases of Malankholia and sleep is important and integral part of the treatment because it produces Rotūbat (moisture) in the brain and also increases the sleeping hours.
Taqwiyat-e-Qalb: Strengthening of the heart through Mufarrehat-e-Qalb (exhilarants) is necessary line of treatment after evacuation of humors from the body as stated by various Unani scholars. Curative therapy deals to correct or otherwise physiologically, pharmacologically, or biomedically wipe out or alter or reverse the symptoms for normal human behavior.
Ilaj bil Ghiza (Dietotherapy): Unani scholars prescribe diet to the patients of anxiety (Izteraab-e- Nafsaani) based on humoral theory, so that the correction of the Su-e- Mizaj (Abnormal temperament) will be done. Following are the few principles generally suggested by renowned Unani scholars are:
- Murattib Aghziyah (emollient diet) such as barley water, cucumber, pumpkin watermelon, milk, green leafy vegetables like spinach, and a light diet should be given.
- The diet producing yellow and black bile should be avoided, e.g., astringent and salty.
Ilaj bil dawa (Pharmacotherapy): Unani physicians have used many single and compound drugs to treat anxiety (Izteraab-e- Nafsaani), which is mentioned in their classical texts. The purpose of the drugs used in the Unani system of medicine is the correction of Su-e- Mizaj (Abnormal Temperament) as they were of the opinion that anxiety (Izterab-e- Nafsani) is due to Su-e- Mizaj Har Sada and Su-e- Mizaj Maddi i.e Su-e- Mizaj Safrawi and Su-e- Mizaj Saudawi.
In Su-e- Mizaj Har Sada, Musakkin-e- dimagh advia such as Alu Bukhara (Prunus domestica), Khurfa (Portulaca oleracea), Tabasheer (Bambusa arundinacea), Kahu (Lactuca sativa), Gaonzaban (borago officinalis) are advised. In Su-e- Mizaj Maddi for restoring equable temperament, excess humor is excreted out through tanqiya (removal) and Ta’deel-e- Mizaj (restoration of normal temperament) with their respective drugs.
Compound Unani Formulations: Some of the polyherbal compound drugs (Murakkab advia) used by Unani physicians for anxiety are: Itreefal Zamaani, Sharbat Ahmad Shahi, Muffareh A’zam, Mufarreh Baarid and Muffareh Yaqooti Mo’atadil (orally), Roghan-e- Labub Saba, Roghan-e- Kahu (locally) etc. should be used.
CONCLUSION: The function of the body, whether health or disease, are regulated mainly by four humors. Anxiety (including generalized anxiety, panic, post-traumatic stress, obsessive-compulsive, and phobic disorders) is a principal symptom of diverse mental disorders. The causative factor of izterab-e-nafsani is Ghalba-e-Sauda/Safra (abnormal production of bile), which in due course of time /in chronic course is transformed into Sauda (Sauda-e-ghair taba’i) due to more oxidation within humours (Akhlat). Evacuation and excretion of Ghair Taba’i Sauda or Safra through Munzijat (concoctive), and Mushilat (purgatives), followed by Tarteeb (moisturizing) is the baseline of treatment.
ACKNOWLEDGEMENT: Nil
CONFLICT OF INTEREST: Nil
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How to cite this article:
Faiz A, Ali F and Qadeer A: Psychosomatic effects of anxiety (Iztarab-e-nafsani) and its management. Int J Pharmacognosy 2023; 10(7): 371-74. doi link: http://dx.doi.org/10.13040/IJPSR.0975-8232.IJP.10(7).371-74.
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Abul Faiz *, Ferasat Ali and Ashhar Qadeer
Regional Research Institute of Unani Medicine, Aligarh, Uttar Pradesh, India.
faiz.abul91@gmail.com
10 July 2023
18 July 2023
26 July 2023
10.13040/IJPSR.0975-8232.IJP.10(7).371-74
31 July 2023